Sean Robert Cushing, PA-C
Physician Assistant, Medical in Portland, OR. Individual provider (NPI-1).
NPI number1457519829
StatusActive
Last updated in NPPESDec 12, 2016
Details
- NPI
- 1457519829
- Entity type
- Individual (NPI-1)
- Name
- Mr. Sean Robert Cushing
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 2, 2008
- Last updated
- Dec 12, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | PA 153108 | OR | Yes |
| 363AM0700X | Physician Assistant, Medical | PA 19589 | CA |
Practice location
10123 Se Market StPortland, OR 97216-2532
Phone 503-251-6168
Mailing address
5806 Ne 23rd AvePortland, OR 97211-2710
Phone 971-235-5913
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